Bill Boan loved it all: apple pie with French vanilla ice cream, a cup of syrup with his pancakes, sweet tea twice a day with 5 to 6 tablespoons of sugar a pop. But when the 79-year-old was diagnosed with diabetes five years ago, he immediately lost his sweet tooth.
Now he starts his day with low-carb cereal. He eats a couple salads every day and snacks on unsalted saltines with peanut butter or cottage cheese with fruit cups. He puts Splenda in his sweet tea and walks with his wife four to five times a week. "It's not a diet. It's a lifestyle change," says Boan, who lives in Gainesville, Florida. "I'm still not on medication after four-and-a-half years."
It was worth it for Boan to give up sweets to not have to take medications or worry about possible side effects associated with Type 2 diabetes, such as heart disease, hearing impairment or eye and foot damage. Certainly Boan's approach -- cutting out carbohydrate-rich foods -- is one way to deal with a diabetes diagnosis.
But such extremes, while laudable, are not entirely necessary, says Linda Delahanty, assistant professor of medicine at Harvard Medical School and director of nutrition and behavioral research at the Massachusetts General Hospital Diabetes Center.
Cutting Back -- Not Out
Delahanty instead recommends scaling back on portion size. "You can have both pasta and bread in moderate portions," she says. "A lot of people with diabetes think they need to avoid them altogether, which isn't true."
Margaret Powers, president-elect of health care and education at the American Diabetes Association, says she advises people to "maintain the pleasure of food ... We actually say that we can work in most foods." But moderation is key, she adds, as well as divvying up portions of carbohydrates throughout the day. "Their bodies just can't handle a whole bucket of carbs at one time."
People with diabetes should also learn to scrutinize labels. Eye the carbohydrates, not straight sugars, she explains, because carbs break down into sugars. However, carb-heavy food might also be high in protein, which helps the body absorb the sugars more slowly.
Another no-no: fats, which deceptively pack on the calories in the form of salad dressing that you pour (instead of apportion) or foods laden with butter or margarine, Delahanty says. Even olive oil, she adds, has 165 calories per tablespoon.
Ultimately, what you need to watch out for are calories, she continues. Diabetics are almost always overweight or obese -- unless they have a genetic predisposition to the disease -- so simply losing weight will often help balance out the glucose level in the blood. "The day they reduce their calories is the day their blood sugar improves even before they've lost the first pound," Delahanty says, adding that weight loss has a certain "blanketing effect." "It's more powerful to focus on weight loss and reducing overall calories."
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Beware: Sugary Drinks
One food that does have to go when you are diagnosed with diabetes is the sugary drink -- be it soda, sweet tea or fruit juices -- even if they are freshly squeezed or juiced, Delahanty says. "They think you're not supposed to drink Coke, but that fruit juice is OK. And that's a big misconception."
That's because the sugar in such drinks is more quickly absorbed into the bloodstream than fruit itself. Juicing in particular removes the pulp and fiber from the fruit -- things that ordinarily slow down the pace with which sugar is absorbed in the bloodstream.
Another culprit is low-fat milk, Delahanty continues, adding that milk with more fat in it is a better choice for people with diabetes because the fat slows down digestion, which also slows down absorption of sugar in the blood stream. Smoothies are another no-no, with their double whammy of liquid sugar in the milk and the sugar from fruit, Delahanty adds.
But one liquid that doesn't have to go is wine. Although wine has a lot of sugar, the alcohol neutralizes it. And even beer, despite its high-carbohydrate content, is OK for the same reason, she says. "Alcohol has the effect of lowering the blood sugar over time." Just don't overdo it -- let moderation be your mantra.
And when you do slip up and overeat, "Don't beat yourself up. Enjoy it," Powers adds. As a dietitian, she counsels people on their diets. "We try not to be over-restrictive. There are people out there to help people with diabetes find the best food plan for themselves."